Disease in a Debt Crisis: Financing Global Health, Development and AIDS between WHO and World Bank, 1978–87

Reiko Kanazawa

doi:10.1017/mdh.2020.17

Abstract

This article examines how international organisations with mandates in health and development interpret global economic crises and respond to disease. It contributes the perspective of World Bank to emerging scholarship on the various factors leading to the decline of the World Health Organization (WHO) and its Health for All (HFA) mission during structural adjustment. It does so by telling a story of collaboration and conflict between WHO and World Bank’s Population, Health and Nutrition (PHN) Department following the ambitious Alma Ata Declaration in 1978 until the initial global AIDS response. As debt crises emerged in Latin America in the early 1980s, WHO tried to find a way forward for HFA. However, the African crisis of 1985 fractured the international community’s support, causing WHO and PHN to dialogue more closely regarding health sector financing. As AIDS became a global crisis, this culminated in their 1987 joint research on the disease’s macroeconomic and demographic impact. However, observing WHO’s continued hesitance regarding financing and its decision to act as a donor gatekeeper, the Bank ultimately opted to work separately in AIDS. Thus, the themes of the Alma Ata versus Selective Primary Health Care debate of the late 1970s continued throughout the 1980s into the early years of the global AIDS response: a perennial conflict of financing within resource constraints and the appropriate role of donors in the grand project of health and development.

Highlights

In the wake of the 2008 global financial crisis, the World Health Organization (WHO) once again reoriented its focus towards the social determinants of health.[1]
This article has related a story of collaboration and disagreement in global health financing during structural adjustment
Incorporating archival data from World Bank and focusing on its dynamics with WHO, it has contributed to historical understandings of the aftermath of the Alma Ata versus Selective Primary Healthcare debate in the late 1970s throughout the debt crises of the 1980s to the early era of global AIDS

Summary

Introduction

In the wake of the 2008 global financial crisis, the World Health Organization (WHO) once again reoriented its focus towards the social determinants of health.[1]. The relationship between WHO and PHN was complex and interdependent during structural adjustment, as the lines between health and development blurred Both institutions were concerned about the health sector austerity measures that the IMF and the International Bank for Reconstruction and Development (IBRD) conditional loans dictated and HFA was a powerful statement that provided a common framework, until the mid-1980s. It looks at how WHO and PHN both re-strategised their health work amidst balance of payments crises emerging in Latin American countries in the early 1980s. It shows that the African crisis of 1985 was a critical test for the logic underpinning HFA, ushering in the era of health systems financing. This article situates global health in the 1980s within broader narratives of international development and financing, making a case for histories that relate complex interactions between multiple actors.[14]

Debt Crises after Alma Ata vs Selective Primary Health Care

Conclusion